CMS Attempts to Curb Medicare Fraud The Centers for Medicare and Medicaid Services (CMS) is issuing new rules to help prevent Medicare fraud and abuse by barring physicians with unpaid debt from re-entering the system and ejecting providers who have … Read More
Rite Aid Corporation, a Delaware corporation and national retail drugstore chain with its principal place of business in Camp Hill, Pennsylvania, has paid the United States $2.99 million to resolve allegations that it violated the False Claims Act by inappropriately … Read More
The Corporate Whistleblower Center says, “We think there are enormous opportunities for in-home healthcare, or managers at hospice companies to cash in on lucrative federal whistleblower rewards, if they possess well documented proof the employer is overbilling Medicare, or Medicaid … Read More
Following a South Florida Medicare and Medicaid fraud scandal that knew no borders, Coral-Gables-based HMO Florida Healthcare Plus is laying the groundwork to continue servicing its members in 16 counties. Earlier this year, 11 South Florida residents were indicted on … Read More
December 2, 2014 — A Texas appeals court has invalidated several rules related to payment holds imposed during Medicaid fraud investigations, saying they violate due process rights. The Third Court of Appeals invalidated rules that authorized the Texas Office of … Read More
The State agency complied with the requirements of the Affordable Care Act in its review of cases for which there were credible allegations of fraud. In addition, the Surveillance and Integrity Review Section implemented its policies and procedures to address … Read More
It’s been 20 months since the Jindal administration canceled a nearly $200 million Medicaid claims processing contract amid allegations of improprieties in the way it was awarded. During that time, the administration has not sought any new proposals from private … Read More
The Statesman reports today that HHSC’s chief counsel Jack Stick, former OIG director for enforcement, who steered business to an Austin software firm for OIG Medicaid fraud detection data mining software, has for years had close connections to the firm’s … Read More
The state health agency’s top lawyer, instrumental in steering more than $110 million in contracts to an Austin tech company, is a former business partner with that company’s lobbyist, state records show. Records show that beginning in 2002 Jack Stick, … Read More
Houston Chronicle business columnist Chris Tomlinson blasted the Texas Health and Human Services Commission Office of Inspector General for its treatment of Medicaid providers in his column Wednesday. His criticism however goes further than OIG and alleges that OIG’s overzealousness … Read More
Judge rightfully reins in anti-fraud unit after abusive action By Chris TomlinsonNovember 26, 2014 Doctors, dentists and other health care providers who care for the state’s most disadvantaged got some much needed relief Tuesday from an over-zealous, politically motivated anti-fraud … Read More
Law360, Dallas (November 25, 2014, 5:55 PM ET) — A Texas appeals court on Tuesday invalidated three Texas Health and Human Services Commission rules related to payment holds imposed during Medicaid fraud investigations, holding they violate due process rights. The … Read More
AUSTIN – Texas officials have been illegally withholding millions of dollars from dozens of dentists and orthodontists based on only the suspicion of minor wrongdoing, an appeals court ruled Tuesday, dealing another blow to the state’s beleaguered unit charged with … Read More
The Texas agency charged with investigating health care fraud suffered a serious setback Tuesday, when a state appeals court ruled that the Health and Human Services Commission’s Office of Inspector General’s expansive use of a key tactic — withholding Medicaid … Read More
Today, the Texas 3rd Court of Appeals overturned a lower court decision and negated Health and Human Services Commission rules that allow for the Office of Inspector General to place Medicaid payment holds in certain circumstances, basically for only program violations … Read More
As Texas’ top health officials steer $110 million in no-bid contracts to an Austin tech company they say is revolutionizing Medicaid fraud investigations, the state’s top contract manager says those contracts are too loosely written and raise questions about what … Read More
One of the nation’s largest nursing home chains will pay $38 million to settle federal claims that the company inappropriately billed for physical therapy and provided poor care that was “effectively worthless,” the Department of Justice reported. The agreement reached … Read More
Two Georgia health care clinic operators are wanted on 24 federal charges of health care fraud after law enforcement officials said the pair bilked Medicaid and Medicare of millions in false claims. Miguel Angel Hernandez and Maria del Pilar Moreira … Read More
ALBANY—The state’s Medicaid Inspector General, James Cox, will join a number of first-term Cuomo appointees who are departing the administration. Cox, who was appointed in July 2011 by Governor Andrew Cuomo to head the Office of Medicaid Inspector General, emailed … Read More
A former CFO at a now-shuttered hospital has pleaded guilty to submitting false documents so the medical center could receive $785,000 in payments under the HITECH Act electronic health records financial incentive program. Some legal experts predict that more federal … Read More
November 18, 2014 — The Texas agency charged with investigating Medicaid fraud is finalizing a $90 million contract for Medicaid fraud detection software. of software licenses and services from the company, 21CT, according to a statesman.com story . Austin-based 21CT is a … Read More
Last Thursday, November 13th, the Texas Sunset Advisory Commission held public hearings about its staff report on the Texas Health and Human Services Commission that was released in October. The Commission heard over nine straight hours of submissions from various … Read More
The United States Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) released its Fiscal Year 2015 Work Plan (“2015 Plan”) on October 31, 2014. OIG releases a work plan annually to identify the new and ongoing investigative, enforcement … Read More
Federal False Claims Act cases are tough on defendants and their lawyers. The stakes are always high with the risk of treble damages, significant penalties per claim and the imposition of relator attorney fees. And the government and the whistleblowers … Read More
The Austin American Statesman reported this weekend that the Texas Health and Human Services Commission Office of Inspector General is finalizing a deal with an Austin company for Medicaid fraud detection software. The company involved, 21CT, is primarily a defense … Read More
AUSTIN, Texas (AP) — The state office responsible for investigating Medicaid fraud and waste is finalizing a $90 million contract with an Austin company that has little experience with Medicaid spending. The inspector general’s office for the Texas Health and … Read More
The state office charged with investigating Medicaid fraud and waste, criticized this week by state auditors and legislators as dysfunctional and “broken,” is finalizing a $90 million contract with an Austin analytics company that had no experience with Medicaid before … Read More
The Texas Sunset Commission held public hearing both Wednesday and Thursday this week on the Health and Human Services Commission as well as its beleaguered Office of Inspector General. Sunset and HHSC staff testified on Wednesday about the recent Sunset Commission … Read More
Responding to an audit critical of the state’s network of health agencies, as well as the embattled Medicaid fraud investigative unit, a panel of state lawmakers this week endorsed an overhaul of the state’s umbrella health agency, the Health and … Read More
TDMR is republishing this very descriptive and apt blog post. A Senseless Fraud Prosecution Victimized Doctor And Patients by Larry M. Elkin, CPA, CFP® In the complicated world of medical and dental care, billing mistakes happen. Add a complicated government … Read More
From the blog of Knicole Emanuel, a NC Medicaid attorney. Whew…the election is over. No more political ads, emails, and other propaganda… Ok, so we have our new elected officials, now our new elected officials need to pass some new … Read More
Daybreak Venture, LLC, the general partner of 74 skilled nursing and long-term-care facilities throughout Texas, entered into a settlement agreement with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, effective October 24, 2014. … Read More
ALBANY—Visiting Nurse Services, the nation’s largest nonprofit home-health care company, will pay $35 million to the federal Medicaid program to settle a civil suit alleging it enrolled more than 1,700 people into Medicaid plans who were ineligible.The lawsuit, filed by … Read More
WHAT WE FOUND We identified 94 general dentists and 1 oral surgeon in Indiana with questionable billing. These providers are extreme outliers when compared to their peers. Medicaid paid these providers $30.5 million for pediatric dental services in 2012. These … Read More
A former Medicaid fraud investigator has won his federal whistleblower suit against his former employer, the Florida Attorney General’s office. According to court records, Ballenger Charles repeatedly told federal authorities the AG’s office was not investigating Medicaid providers only recipients. … Read More
A Nampa home health care service operator has been ordered to reimburse the state, perform 40 hours of community service and pay court costs and fines after pleading guilty to Medicaid fraud. The Idaho Attorney General’s office says 66-year-old Cline … Read More
Federal authorities say a former Parkland Memorial Hospital employee illegally used information from thousands of patients to defraud Medicare and Medicaid. Viju Mathew, 49, of Garland has agreed to plead guilty to a federal fraud charge and is scheduled to … Read More
The Texas Rangers are now investigating the Health and Human Services Commission Office of Inspector General and the firing of actuary Brad Nelson per a story in the Houston Chronicle. The Commission requested the investigation after Nelson was fired for … Read More
A Stillwater-based dental company has agreed to pay more than $5 million in civil claims stemming from allegations that it submitted false Medicaid claims. Ocean Dental PC, which operates 28 clinics in seven states, did not admit any liability in … Read More
On October 22, 2014, the Department of Justice (DOJ) announced that DaVita Healthcare Partners, Inc. (DaVita), a provider of dialysis services, has agreed to pay the U.S. Government $350 million for allegedly violating several provisions of the False Claims Act … Read More
